@layout("/backend/common/_container.html"){
<div class="dhcc-form">

    <form method='post' id="cdcExpenseInfoForm" name="cdcExpenseInfoForm" enctype="multipart/form-data">
	
        <#Hidden id="id" value=""/>
	
		<#Input id="episodeId" name="就诊记录"/>
		<#Input id="costs" name="总费"/>
		<#Input id="pays" name="自付费"/>
		<#Input id="busExpenseTypeId" name="费用类型"/>
		<#Input id="dataId" name="业务数据类型"/>
		<#Input id="isActive" name="是否有效"/>
        <div class="toolbar">
            <#Button name="保存" id="ensure" icon="icon-w-save" clickFun="CdcExpenseInfoDlg.addSubmit()"/>
            <#Button btnCss="l-bt-red" name="关闭" id="cancel" icon="icon-w-close" clickFun="CdcExpenseInfoDlg.close()"/>
        </div>
    
    </form>
</div>
<script src="${ctxPath}/static/backend/cdc/cdcexpense/cdcexpense_info.js"></script>
@}
